Oveisgharan Shahram, Organji Hosein, Ghorbani Askar
Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.
Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Stroke Cerebrovasc Dis. 2018 Jan;27(1):185-191. doi: 10.1016/j.jstrokecerebrovasdis.2017.08.026. Epub 2017 Sep 8.
Two previous studies, which investigated transcranial direct current stimulation (tDCS) use in motor recovery after acute ischemic stroke, did not show tDCS to be effective in this regard. We speculated that additional left dorsolateral prefrontal cortex (DLPFC) stimulation may enhance poststroke motor recovery.
In the present randomized clinical trial, 20 acute ischemic stroke patients were recruited. Patients received real motor cortex (M1) stimulation in both arms of the trial. The 2 arms differed in terms of real versus sham stimulation over the left DLPFC. The motor component of the Fugl-Meyer upper extremity assessment (FM) and Action Research Arm Test (ARAT) scores were used to assess primary outcomes, and nonlinear mixed effects models were used for data analyses.
Primary outcome measures improved more and faster among the real stimulation group. During the first days of stimulations, the sham group's FM scores increased by 1.2 per day, while the real group's scores increased by 1.7 per day (P = .003). In the following days, FM improvement decelerated in both groups. Based on the derived models, a stroke patient with a baseline FM score of 15 improves to 32 in the sham stimulation group and to 41 in the real stimulation group within the first month after stroke. Models with ARAT scores yielded nearly similar results. No significant adverse effect was reported.
The current study results showed that left DLPFC stimulation in conjunction with M1 stimulation resulted in better motor recovery than M1 stimulation alone.
之前有两项关于经颅直流电刺激（tDCS）用于急性缺血性中风后运动恢复的研究，未显示tDCS在这方面有效。我们推测额外刺激左侧背外侧前额叶皮质（DLPFC）可能会增强中风后的运动恢复。
在本随机临床试验中，招募了20名急性缺血性中风患者。在试验的两个组中，患者均接受了实际的运动皮质（M1）刺激。两组的区别在于对左侧DLPFC进行实际刺激还是假刺激。采用Fugl-Meyer上肢评估（FM）和动作研究臂测试（ARAT）的运动部分评分来评估主要结局，并使用非线性混合效应模型进行数据分析。
实际刺激组的主要结局指标改善得更多且更快。在刺激的头几天，假刺激组的FM评分每天增加1.2，而实际刺激组的评分每天增加1.7（P = 0.003）。在接下来的日子里，两组的FM改善速度均减慢。根据推导模型，一名基线FM评分为15的中风患者在中风后的第一个月内，假刺激组的评分提高到32，实际刺激组的评分提高到41。ARAT评分模型得出了几乎相似的结果。未报告明显的不良反应。
当前研究结果表明，与单独的M1刺激相比，联合M1刺激和左侧DLPFC刺激可带来更好的运动恢复。
